Rovira, A;
Dawson, D;
Walker, A;
Tornari, C;
Dinham, A;
Foden, N;
Surda, P;
Archer, S;
Lonsdale, D;
Ball, J;
et al.
Rovira, A; Dawson, D; Walker, A; Tornari, C; Dinham, A; Foden, N; Surda, P; Archer, S; Lonsdale, D; Ball, J; Ofo, E; Karagama, Y; Odutoye, T; Little, S; Simo, R; Arora, A
(2021)
Tracheostomy care and decannulation during the COVID-19 pandemic. A multidisciplinary clinical practice guideline.
Eur Arch Otorhinolaryngol, 278 (2).
pp. 313-321.
ISSN 1434-4726
https://doi.org/10.1007/s00405-020-06126-0
SGUL Authors: Lonsdale, Dagan
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Abstract
PURPOSE: Traditional critical care dogma regarding the benefits of early tracheostomy during invasive ventilation has had to be revisited due to the risk of COVID-19 to patients and healthcare staff. Standard practises that have evolved to minimise the risks associated with tracheostomy must be comprehensively reviewed in light of the numerous potential episodes for aerosol generating procedures. We meet the urgent need for safe practise standards by presenting the experience of two major London teaching hospitals, and synthesise our findings into an evidence-based guideline for multidisciplinary care of the tracheostomy patient. METHODS: This is a narrative review presenting the extensive experience of over 120 patients with tracheostomy, with a pragmatic analysis of currently available evidence for safe tracheostomy care in COVID-19 patients. RESULTS: Tracheostomy care involves many potentially aerosol generating procedures which may pose a risk of viral transmission to staff and patients. We make a series of recommendations to ameliorate this risk through infection control strategies, equipment modification, and individualised decannulation protocols. In addition, we discuss the multidisciplinary collaboration that is absolutely fundamental to safe and effective practise. CONCLUSION: COVID-19 requires a radical rethink of many tenets of tracheostomy care, and controversy continues to exist regarding the optimal techniques to minimise risk to patients and healthcare workers. Safe practise requires a coordinated multidisciplinary team approach to infection control, weaning and decannulation, with integrated processes for continuous prospective data collection and audit.
Item Type: | Article | ||||||||
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Additional Information: | This is a post-peer-review, pre-copyedit version of an article published in European Archives of Oto-Rhino-Laryngology. The final authenticated version is available online at: http://dx.doi.org/10.1007/s00405-020-06126-0 | ||||||||
Keywords: | COVID, Multidisciplinary, Novel coronavirus, Tracheostomy care, Tracheostomy care, COVID, Multidisciplinary, Novel coronavirus, Otorhinolaryngology, 1103 Clinical Sciences | ||||||||
SGUL Research Institute / Research Centre: | Academic Structure > Institute of Medical & Biomedical Education (IMBE) Academic Structure > Institute of Medical & Biomedical Education (IMBE) > Centre for Biomedical Education (INMEBE) |
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Journal or Publication Title: | Eur Arch Otorhinolaryngol | ||||||||
ISSN: | 1434-4726 | ||||||||
Language: | eng | ||||||||
Dates: |
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Publisher License: | Publisher's own licence | ||||||||
PubMed ID: | 32556788 | ||||||||
Web of Science ID: | WOS:000541025400001 | ||||||||
Go to PubMed abstract | |||||||||
URI: | https://openaccess.sgul.ac.uk/id/eprint/112071 | ||||||||
Publisher's version: | https://doi.org/10.1007/s00405-020-06126-0 |
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